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Becker’s Healthcare Podcast
Driving Nurse Engagement and Throughput Innovation at Maimonides with Frankie Hamilton
00:22:08
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- [00:00]
A
Hi, everyone. This is Erica Carbajal with Becker's Hospital Review. Thank you so much for tuning in to this episode of the Becker's Healthcare Podcast. Today we're joined by Frankie Hamilton, vice President of Nursing Operations at Maimonides Medical center in New York. Franke, welcome, welcome. Thank you so much for taking the time.
- [00:22]
B
Thank you for having me, Erica. I appreciate it.
- [00:24]
A
Yeah. Pleasure to have you on today. Do you want to start by sharing a little bit about your role, your organization, and the scope of your work?
- [00:34]
B
Sure. So I joined the Maimonides team about almost a year ago in March of 2025. I came here in the role of Vice President of Nursing Operations, which is a title that was, I think, newer to the organization. And in my role, I oversee nine medicine units, as well as our dialysis unit, which only covers inpatients. We don't have outpatient services for dialysis at the moment. I also cover the nursing administration office, which houses our float pools, as well as our nursing administrative directors, who keep the hospital running on the evening, night, and weekend shifts. And I also sort of am in charge of special nursing projects and initiatives that come up throughout the course of our daily operations. And so that includes, like, working with some vendors and bringing in new products. And of course, that's in collaboration with all of our other nursing departments. Quality Department, Nursing Practice and Innovation, Nursing Education. So my job is definitely not siloed for sure. And then I also will be in charge of our ANCC Magnet Designation Application project slash initiative, which we will be applying for Magnet Designation soon, possibly within the next year or two. And I will be. That will be under my book of work as well. So we'll be hiring a magnet program director and I'll be working on our entire magnet journey alongside whoever is chosen for that. For that role.
- [02:14]
A
Yeah. Thanks, Frankie. Well, congrats on almost a year here. You oversee a lot. And know you mentioned your role isn't siloed, and it certainly sounds that way. I know Magnet designation is no small feat. There's so much work that goes into applying for those and achieving that designee. So thank you for sharing that helpful context. Frankie, I know you mentioned you are coming up on a year, so what was maybe the most important initiative you've led since you've joined?
- [02:44]
B
What.
- [02:45]
A
What was it? And what were some of the results?
- [02:48]
B
Sure. So for me, I guess I have worked night shift for a lot of my nursing career. I've worked night shift many years as a clinical bedside nurse and then also when I have held roles in Nursing administration as an assistant director for nursing or nursing administrator, where I covered the hospital on the night shift. And since that team reports up through me, I noticed that there were some areas of opportunity that we could really work on improving and streamlining communication between the different departments on the night shift. So, you know, after really kind of learning the ways of the land here at Maimonides and understanding where there were areas of growth, I realized that there was opportunity to implement a night shift safety huddle. So there was already a safety huddle in place for the day shift, and that takes place every morning with all the. The department leadership from all the different disciplines, ancillary departments, nursing, physicians, and, you know, the whole point of that safety huddle is to escalate any concerns that might need to be addressed immediately throughout that day to make sure that there are safety measures in place and to make sure that things that are, you know, barriers or challenges are taken care of and remedied as expeditiously as possible. So we were missing that on the night shift. So when I spoke with our CNO, he was 100% behind initiating the same type of huddle and mirroring that for the night shift. So I think that's one of the initiatives that I'm most proud of, is bringing that sort of communication platform to the night shift so that we have a similar type of structure and process in place where the interdisciplinary teams can come together, the nursing teams, you know, nursing leaders who work at night, as well as engineering and environmental services and biomed, where they can come together and report out from their areas any barriers or challenges they might be experiencing that are going to impact patient care or patient flow or, or operations. So, you know, from that, I think there has been better engagement from the night shift, and I think the night shift have appreciated the better communication coming from those different departments. Because sometimes, you know, as a night shift former night shift nurse myself, sometimes night shift can feel left out. And so I think this 9:30pm huddle brings people together, establishes relationships, which is really important for the night shift. When there are less people around, you want to know the people who are there and the players that are going to be able to help you out in the different departments. So I think I've seen a lot of success and heard anecdotally from the nursing administrative directors who cover the night shift as nurse leaders, as well as the different team members who are part of the huddle that this new platform has helped to streamline communication, to enhance, you know, throughput and to just bring awareness to the current state of affairs of things happening on the night shift that are possibly going to impact the workflows for the staff. So it's been really successful and we are going to continue that. It happens on the weekends as well, on Saturday and Sunday, morning and night. So there's continuity of communication throughout all shifts. And I think that's really, you know, as we know in healthcare, most errors are caused by lack of communication or miscommunication. So. So in this case, this platform has served to really try to enhance the dialogue between teams. So I'm really proud of it and looking forward to its continued success as we continue on.
- [06:37]
A
Yeah, Frankie, what a great initiative. I mean, safety hulls, I know, are so important, so it's great to hear that they've been in place on Night Shift 2 and that it is improving engagement among the night shift staff and I imagine just improving overall, like, communication in terms of shift changes. I know that's another area of concern and that can be a challenge. So I imagine being able to just have that space and time to talk through what's happening, have more awareness on challenges that might need to be addressed, just trickles into the whole rest of the shift and following people who are going to be coming in and taking over after those shifts, too.
- [07:17]
B
Absolutely. And even anything happening, oh, we're going to have be shutting down the Tube station, you know, at this time or during this day. Just those types of informational things are important for the night shift, so they also feel connected and they know what's happening.
- [07:32]
A
Yeah, definitely has a big impact on continuity. Well, Frankie, looking ahead, what is maybe a big priority or a headwind that you're encountering or planning expecting to encounter this year?
- [07:46]
B
So for. For us, for, for nursing, one area that we're doing really well on is nurse retention. You know, as a nurse leader, there's these buckets that you're always focused on. One of them is always staffing to make sure that we have the right staff in place to serve the needs of our community. You know, at my monies, we are outperforming the nation in terms of nurse retention and we're doing really well with that, which is phenomenal. And. And we're really excited and proud of that as well. So that's one thing that we don't need to focus on as much. You know, we are, of course, working on always improving nurse engagement, and that's one of the areas that I always like to focus on, and that includes just for all shifts, so day and night shift. And again, not to be, I'm not biased, but as a former night shift nurse, you know, I do recognize the challenges of some night shift staff feeling disconnected. So I do prioritize making sure that the night shift do feel like they are part of the team and that they are feeling valued and seen and appreciated in addition to the day shift. So engagement is definitely one of the areas I'm going to be focusing on for this next year. And again, it's going to be focusing on all areas and departments within nursing, including night shift. So, for example, we had a Valentine's Day nighttime celebration last week with cookies and karaoke, which was super fun and it was a huge turnout and it was just really great to see the night shift show up and show out and really have a good time. And that's an area that I want to make sure I continue to look at because you need to bring joy into the workplace. And healthcare is just such a dynamic and ever evolving and quite honestly challenging environment to work in. So without having those fun things incorporated, you know, it can become really burdensome. So trying to encourage staff to get involved, to join our professional governance councils to have their voices heard, to really increase nursing's sense of autonomy and engagement and belonging. And so that's one area that we're definitely going to be looking at. The other area, of course, is nursing quality. And we continue to focus on the standard nursing quality metrics, our hospital acquired pressure injuries, our catheter associated UTIs, our central line associated bloodstream infections, and our patient falls. So we have really made wonderful strides in our quality metrics, but the work is never done and it's always it's continuous process improvement. So we are going to be continuing to focus on our quality goals as we continue on this, this new year and make sure that we are doing even better than we did last year. And there's always room for improvement. So, you know, making sure the nurses, you know, we're going to look at implementing champion models so that we have our falls champions and we have our clabsi champions and make sure that the nurses are feeling empowered and also engaged in the work that they're doing to prevent hospital acquired infections. And then the third area that I would say we're really going to be looking at is our patient experience. So we, you know, we are doing pretty well with patient experience metrics in relation to the Brooklyn Hospitals, but we want to make sure that we're still striving to improve. So with that, we're going to be looking at enhancing Nurse leader rounding on both the day shift and the night shift, which we're hoping will identify barriers or things that are impacting patient satisfaction early in their stay. So we can remedy those and take care of them immediately and prevent that from showing up on a survey at the end when they're discharged and it's too late to intervene. So, you know, I think those are the three buckets that we're definitely going to be putting a lot of our energy towards to improve our patients happiness and satisfaction with our hospital experience as well as their, their quality outcomes.
- [11:56]
A
Yeah, Frankie, three really important areas and I think what you mentioned about nurse engagement, it's interesting because it feels like that piece really runs through all the rest, like being able to, you know, move the needle on patient experience and quality all really kind of bolts back to nurse engagement in the first place. So I thought that that was just interesting. And, and I know nurse engagement and just participation on committees and governance councils can be a challenge in certain areas, especially when it comes to night nurses too, and hospitals and health systems kind of looking at different ways to structure things and give folks more flexibility to participate in some of these things. So I was curious if you could follow up on that just in terms of, are you looking at any specific ways to get night nurses more involved on certain things, especially, you know, governance councils.
- [12:51]
B
Oh, absolutely, yeah. So, you know, we do have some nurse leaders who are in charge of the professional governance councils and there are two that are in charge of the night shift council specifically and they hold them via webex to allow staff to log in from home or if they're on the unit, they can log in from the unit. So trying to offer that hybrid in person webex platform really enhances participation because people can either log in and listen passively or they can log in and be active participants either from the nurses station or from home. So that was one of the suggestions from the NYCHA staff themselves to allow the webex option so that people could attend if they wanted to and if they happen to not be working that night and also just offering people opportunity to, to join these meetings if it's extra time. So, you know, maybe they can book a shift and they'll work the night shift, but if the council is meeting, maybe they'll be non productive and they'll be part of the meeting and then the rest of their shift they can help do chart audits or they can do chart reviews and do some teaching to their colleagues or things of that nature. So trying to be flexible and creative in the way that we schedule our staff so that we do have maximum participation for the. For the night shift specifically. But the same applies to the day shift. So if people want to come in for the day shift on days when we have meetings, they can participate in whatever councils they're a part of, and then they can do ad hoc things like chart reviews or, you know, patient rounding or whatever creative ideas our nurse leaders can come up with to make them be active part of the team for that day, but not necessarily taking a patient assignment so that they're able to focus on the meetings and really be part of the. They're the voice that they're wanting to share for those counseling meetings as well as be helpful to their teams at large.
- [14:56]
A
Yeah, sure. That's great. Thanks, Frankie. Well, I wanted to ask you too, just about something we've been following a lot of in the news, which is the lapse of ACA premium tax credits and looming cuts to Medicaid. With both of those, and hearing from a lot of hospital leaders about how they're anticipating a rise in uninsured patients and potentially more strain on their emergency departments. So I was curious to hear from you on how Myamonidis is preparing to care for a spike in uninsured and underinsured patients from a clinical or operational standpoint.
- [15:30]
B
Sure. So, yeah, that's definitely a challenge that we're all bracing for. And a lot of the work that we're doing is really focused on throughput. So we know that, you know, with more uninsured patients, they're usually going to delay coming to the hospital for as long as they possibly can. Unfortunately, that means when they get to the hospital, if they really need to get seen and treated, they're probably going to arrive sicker and they're probably going to require admission. Right. So there's a few things that we're working on that we've been doing to try to enhance throughput. Our ED is already busy as it is, and, you know, we just survived the strike. Obviously, as you're aware of, in New York City, we were expecting to get some overflow of patients from other hospitals locally. However, that did not really impact our operations too, too much. But we did just have a really tough flu season. So we did just have extreme surges in patient volume in the EV that we're still navigating actively. But part of our book of work in addressing ED volumes, which, again, we're going to probably see increased due to more uninsured patients or, you know, it's really, we're going to be working on getting patients out of the hospital as soon as possible when it's safe and to make sure that they were continuing their care outside so that they don't get readmitted. So we can get patients out of the hospital sooner who don't need to be here any longer, then we can get those patients up from the ED to those beds. And then if we can keep those patients who have been discharged out of the hospital and keep them safe at home, then of course we're hopefully not going to see them be readmitted and then that should hopefully, you know, reduce our ED volumes ultimately in the long run. So we do have tasks force on length of stay. I personally am part of a nursing strategic work group related to length of stay with one of my other VPs of cardiology. And so we are implementing some nurse driven checklists to be able to enhance our awareness of what are the outstanding or pending things needed for someone to be discharged. So that our bed expediters, and I'm not sure if you're familiar with that term, but we have bed expediters for each division and they're pretty much in charge of rounding on all the units within their area to see who's planned for discharge and to try to make sure that they get all of their milestones checked off and they can actually be discharged for that day. So we're going to be working with them to implement a new nurse driven checklist that they will be in charge of and that will have all of the elements that are required for discharge and they'll be able to check off for those patients who are leaving that day and engage with teams who need to be escalated to. So if they're pending an X ray before discharge or if they're pending an echo like they'll be able to escalate to those areas to get that done. So we can really streamline the discharge process. So there's a lot of nursing related work being done to improve earlier discharges. You know, our industry standard is discharged before noon. We do decently well with that. But I think with our new nursing strategic initiatives, we're going to be seeing more DBNs as they are abbreviated and then that will hopefully help throughput from the ed. And then on the other end of it, we are partnering with outside organizations. One of them is called mylaural and, and they are helpful in, they do follow up care. So when the patients are discharged, this company, you know, has a nurse follow them at home and ensure that the Patients are, you know, asymptomatic or taking their medications, complying with their treatment regimens, and the goal for them is to prevent readmission. And that, again, trickles back to us to prevent unnecessary ED visits, which will hopefully allow there to be more space for the increased volume of patients that we might see due to the higher rates of uninsured patients in the community. So I think those are some of the initiatives that we're working on.
- [19:42]
A
Yeah, no, definitely. It sounds like, if anything, you know, any additional ED strain that comes through, you know, potentially more uninsured patients is just has really elevated length of stay work and throughput operational efficiency work. So it's interesting to hear logistics of how all of that connects.
- [20:02]
B
Yeah. And there's just one more thing that I do want to mention regarding our staff. So I think, you know, again, with uninsured patients who might be coming to the hospital late, who might be getting diagnosed with illnesses that they may have been ignoring for some time, there's a chance that we are. We're going to be seeing sicker patients and with that more complex needs. And so for our staff, we need to make sure that they are prepared for the potential of, you know, there's always the. The possibility of moral distress. So when we feel like we have patients that we really want to help and get what they need, but there are systemic barriers related to insurance or placement issues or social determinants of health and things of that nature, our staff can sometimes feel a little bit defeated. So I think one of our other areas we can't forget about is our workforce and making sure that they're prepared for, you know, compassion fatigue and for the feeling that maybe they're. They're not seeing the outcomes that they would like to see for all of their patients and making sure we have really good debriefing structures set up. So if there's a difficult case in the hospital where maybe ethics is involved, that we have that platform available for the staff to come together and debrief and talk about their feelings. We do have Team Lavender here, which is a phenomenal support structure that's led by our HR department. And, you know, we actually just called one yesterday for our staff that went through a challenging patient situation. So I think I would be remiss if I didn't also say that one of our areas of focus will be on our. On our nursing staff and our frontline staff to make sure that they are prepared for the challenges that might be coming down the pike.
- [21:46]
A
Yeah, no, such an important point too especially as with the potential for seeing patients who are higher acuity coming in. Well, Frankie, thank you so much for your time today. It was a pleasure to connect and hear about some of the work you're leading at Maimonides.